Fertility Patients' Rights To Be Treated & Keep Their Jobs

In an encouraging step forward, a Federal appeals court in Illinois has ruled that women undergoing IVF should have their employment protected in the same way as pregnant women, through the Pregnancy Discrimination Act.

I’m an involved mom -- besides my busy practice, my family keeps me running. I have the utmost respect for women who are trying to manage work and family with the added stress of infertility treatment. Our office has always maintained very early hours for the primary purpose of facilitating pre-work appointments for patients. I opened my Sugar Land office when I realized how many southwest area patients were squeezing ultrasounds and exams at our central Houston office into their schedules.

The court’s ruling is a first. It’s still quite possible that employers could be less than understanding about patients needing to come in late or leave in the middle of the day so they can follow their physician’s prescribed treatment. But at least a precedent has been set, and it’s one that can be cited if a patient encounters challenges at work.

Wall Street Journal article: Women Battling Infertility Find a Friend in the Court

Technorati Tags: pregnancy discrimination,federal legislation,infertility treatment,patient rights,ivf

Spread The Word: Great Day Houston

On Tuesday, July 29, Houston Infertility Clinic will be featured on Great Day Houston with Debra Duncan.

The show will include interviews with patients Karen and Cliff Nickel (and their two adorable daughters), as well as new patients Reece and Tracy Klepacz who kindly share with the audience their infertility struggle of many years. Plus, the Klepacz' allowed Great Day Houston crew to film their recent egg retrieval here at Houston Infertility Clinic.

Also included will be interviews with an egg donor from Prime Genetics and Chris Axelrad, Clinic Director of The Axelrad Clinic for Natural Fertility Enhancement & Women's Health. They'll be joining me to talk about the many varied solutions to all types of infertility conditions.

Tune in on Tuesday, July 29th at 9 AM on KHOU Channel 11 for Great Day Houston. If you miss the show, you can watch online on their homepage.

[Edited 8-15-08: You'll find full video online here.]

Technorati Tags: infertility treatment,tv show,interviews,patients,doctors,egg retrieval,medical

You Asked For It: Treating PCOS

In an earlier post, Christy asked about PCOS and its treatment. Polycystic Ovarian Syndrome is a complex diagnosis that is relatively easy to treat.

Here are my responses to Christy's questions:

How do you treat [PCOS]?

PCOS is sometimes referred to now as "metabolic syndrome" because the term more accurately reflects the entire condition. For example, not all women with PCOS have ovaries with many cysts.

The goal of treatment is ovulation. Treatment usually consists of oral medication (clomiphene citrate, more commonly referred to by one of its brand names, Clomid).

In the past, another drug, Metformin, was frequently administered in conjunction with Clomid. A couple of years ago, a large study found no advantages to using Metformin strictly for the purpose of getting pregnant. (I wrote about that finding in my November 2006 newsletter.)

How effective is Clomid? Does it work every month?

Clomid is generally effective within the first three cycles of use. Depending on several factors, I may prescribe the medication be used in conjunction with intrauterine insemination (IUI) or timed intercourse.

If a patient is Clomid resistant, what is the next protocol?

If a patient's ovaries are resistant to Clomid, the next step is often gonadotropins, which are administered by injection. Patients who also have abnormal glucose/insulin levels will be prescribed Metformin.

As a side note, it's important that women with PCOS are made aware of the links between that and more serious health conditions like heart disease and diabetes. I encourage all of my patients to make healthy lifestyle changes as needed, not only to increase their chances for pregnancy, but to promote overall better functioning of their total body.

Technorati Tags: pcos,polycystic,metformin,clomid,womens health,getting pregnant,fertility treatment

You Asked For It: Predicting Ov with PCOS

One of my readers asked me to discuss PCOS, in conjunction with my earlier comments on using ovulation predictor kits at home.

It's true that PCOS and several other ovulatory disorders can make home ovulation prediction a very inaccurate process. If you're determined to use at-home testing kits, try to look at the results as information that is helpful but that may not be giving you the full picture of your ovulatory function.

A very important point here: regular menses does not necessarily mean you are ovulating during every cycle. Women with PCOS come with a range of cycles -- from amenorrhea (completely absent periods) to wildly irregular cycles to fairly consistent menstrual periods.

In short, when a woman has PCOS or other ovulatory disorders, menstruation and ovulation may be different, seemingly unrelated events. You can't always use "Aunt Flo" as an indicator of how well your ovaries are working.

Advances in fertility science spawn new issues - Houston Business Journal:

I was interviewed by the Houston Business Journal's Nicole Bradford at our Sugar Land office for this article on egg freezing. It's in their July 4th issue's special section on Health Care. [Edited 8-15-08: The full article is now online and readable by non-subscribers.]

Advances in fertility science spawn new issues - Houston Business Journal:

This photo of a metaphase II oocyte was taken by our Lab Director, Dr. Neil Stoddart, and used on the front page of the July 4 issue of Houston Business Journal.

Technorati Tags: egg freezing,houston business journal,interview,media,dr sonja kristiansen interview,infertility clinic

My Opinion: On DIY Fertility Testing

There was a lot of news attention a few weeks back about a new at-home fertility test. I'm frequently asked for my opinion on such tests by both patients and the media.

While it's certainly understandable in this age of the Internet that empowered, educated patients want to take their health and wellness into their own hands, the distributors and manufacturers of DIY tests often fail to accurately inform consumers about their products' limitations. So I'm glad when people come forward to find out about the bigger picture.

In this case, the test claims to be "a breakthrough test for ovarian reserve" when in actuality, it's a collection of analyses that clinicians have used for many years now. I suppose the "breakthrough" aspect is that folks can use it at home. But should they?

Consumers need to weigh the cost-benefit ratio -- yes, even for health care. I know that I consider numerous aspects before making a substantial purchase, and I'm positive that my patients do, too.

Like other home tests, The Plan Ahead test claims to address two issues common to the topic of getting pregnant: privacy and cost.

It's true that performing a test "at home" is more private than a consultation in my office and a blood draw in the exam room. But in the case of this particular test, the consumer is still required to have their blood drawn by a participating physician. The cost benefit -- in this case, just under $400 -- of such a test is debatable.

There are so many more variables that add up to successful conception and pregnancy that home tests do not and cannot address. Ovarian reserve - a term that refers to a woman's egg supply -- is but one of numerous components that make someone fertile. Likewise, patients sometimes are unable to get pregnant or maintain a pregnancy because of underlying health conditions that will not be detected by home testing.

So the cost of doing-it-yourself in this case could mean that you miss an important diagnosis of an undetected condition. DIY fertility diagnosis can also cost patients crucial time in their journey toward getting pregnant.

While I may sound biased, I think it just makes common sense to go ahead, make sure your bases are covered, and have a consultation with a specialist from the start.

Technorati Tags: infertility testing,ovarian reserve,fertility,plan ahead,diy,health care,at-home tests

POF: Future Help On the Horizon?

In my experience as a fertility specialist - and as a mother - by far one of the most traumatic diagnoses to render to a patient is one of POF, premature ovarian failure.

A POF diagnosis can ring with emotionally painful finality in a patient's mind. It means, in effect, premature menopause, sometimes as early as the woman's 20's. However, I am grateful to have alternatives to present in many cases. For many women with POF, the use of donor eggs with IVF can result in successful pregnancy.

Today there is even better news, even if only of the long-range type. Scientists have found more evidence of genetic connections to the incidence of POF. What this means is that the future may possibly hold a test that can tell very young women of their chance for having POF.

Presumably if a young woman with healthy eggs tests positive for the gene mutation, she could have her healthy existing egg cells retrieved and cryopreserved for later use.

I look forward to every additional opportunity I'm given for presenting a fulfilled future to women with POF.

Oocyte-specific gene mutations cause premature ovarian failure - Baylor College of Medicine

Technorati Tags: premature ovarian failure,pof,infertility treatment,premature menopause,egg freezing